http://connection.asco.org RSS feeds for ASCO Connection – professional networking for ASCO’s worldwide oncology community 60 http://connection.asco.org/Commentary/Article/ID/3479/Women-in-Oncology-A-View-from-the-Trenches.aspx#Comments 1 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3479 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3479&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3479/Women-in-Oncology-A-View-from-the-Trenches.aspx Like many other readers of ascoconnection.org, I was inspired by ASCO president Sandra Swain’s blogs on “Women in Oncology.” Those blogs and the recent publication of Sheryl Sandberg’s empowering book, “Lean In,” have gotten me thinking about the plight of the female oncologist. Back when I completed oncology fellowship, my fellow female classmates and I looked around and saw no women oncologists in positions of leadership. We formed a support group which we cheekily named, “Chick Onc.” We would get together for monthly dinners where we would commiserate over our perceived failures and celebrate our successes. These women remain some of my very best friends and all of us have risen to important positions of leadership at our own institutions—go Chick Onc! Since that time, the landscape for women oncologists has changed. We have a female ASCO president. At my institution, the incoming Chairman (or Chairwoman?) of Medicine is a woman who has done significant oncology research during her impressive career. We have a female fellowship director. At my husband’s institution, the dean of his medical school is a female oncologist and a former ASCO president.   I am proud of what female oncologists have achieved in recent years. But it’s important for all of us in oncology, both men and women, to help keep raising that bar because while we have made tremendous progress, we have a long way to go if we wish to attain gender equality in medicine. Sheryl Sandberg’s book has been lauded but also criticized for her advice to women. For the record, I agree with her point of view that in order for women to succeed, women need to “lean in” and “sit at the table.” At a recent lunchtime faculty conference at my institution, I noticed that besides myself, there were only two other women sitting at the table compared to eight men. All of the other women were sitting in chairs on the side. (Note: I take no credit for my own initiative here. The only reason why I started sitting at the table is because when I used to sit on the side, I routinely dumped my lunch down the front of my shirt.) We can do better. I have the pleasure of mentoring two stellar female oncology fellows, both of whom have the potential to be future leaders in oncology. A regular piece of advice that I give to them is to stop apologizing for their perceived weaknesses and instead, be proud of how brilliant they are. That is in sharp contrast to the advice I give my sons when I tell them the importance of being humble. My boys ignore that advice on a regular basis and maybe that isn’t all bad. Does this point out a fundamental difference in men and women? When I look back at my early Chick Onc days, it is possible that we banded together because as women, we needed each other to validate our accomplishments. In this respect, should women become more like men? Or should society adapt to judge individuals based more on the merit of their work rather than their ability to promote themselves? I don’t pretend to have the answers. But for my part, I’ll keep encouraging my female colleagues to join me at the table. And if we need a bigger table, so be it. Beverly Moy, MD, MPH Sat, 16 Mar 2013 18:17:23 GMT f1397696-738c-4295-afcd-943feb885714:3479 http://connection.asco.org/Commentary/Article/ID/3331/The-Burden-We-Bear.aspx#Comments 1 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3331 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3331&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3331/The-Burden-We-Bear.aspx I recently had the most emotionally difficult experience of my career thus far. I was on call in the inpatient service while a young mother was dying of advanced cancer. Her entire family, including her young son, was on the floor. We tried to prepare the best setting possible for the young boy by having the Chaplain and social worker with him. When he realized what was happening, he started to scream. No one, not his father, grandparents, nor the Chaplain could get him to stop. His grandfather asked me if I could speak to him. Leaving my white coat and my stethoscope at the nurse’s station, I stepped in the room and saw him curled up like a ball with his head in his hands. Two images immediately came to mind. The first was myself as an eight-year-old girl visiting my grandmother in the hospital when she went into cardiac arrest and died. That memory is indelibly burned into my brain. I realized with dread that this young boy would carry whatever I said with him for the rest of his life. I longed to magically find the right words. The second image was me imagining my own son in the same situation. It was then that I realized that I needed to say what I would want someone to say to my own little boy if I were dying. In a way, this helped to focus me. I told him that I knew there was nothing that I could say to make him feel better. That if I were him, I would be screaming too. That his mother loved him. That his father would always do right by him. Understandably, I was emotionally drained and miserable afterwards. These kinds of experiences are part of the burden that we bear as oncologists. But as awful as I felt, I have found comfort in the fact that I should feel upset. The moment that I stop feeling emotions like a compassionate human being when faced with my patients’ death and dying is the moment that I should stop being an oncology caregiver. We are enormously privileged to be a part of people’s lives at their most difficult times in a way that almost no other profession allows. Members of the oncology community should continue to support each other through these difficult experiences in order to give the most compassionate care to our patients and families. Beverly Moy, MD, MPH Thu, 11 Oct 2012 12:18:58 GMT f1397696-738c-4295-afcd-943feb885714:3331 http://connection.asco.org/Commentary/Article/ID/3239/An-Oncologists-Midlife-Crisis.aspx#Comments 0 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3239 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3239&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3239/An-Oncologists-Midlife-Crisis.aspx At my last birthday, my 11-year-old son said, “Congratulations, Mom! You’re halfway done with your life!” Ouch. My dear son’s “funny” joke helped me realize that I am now a mid-level oncologist. This came as a bit of a surprise to me because frankly, it seems like just yesterday I was a junior oncologist. In truth, I probably should have realized this sooner because for a few years, my more junior colleagues have sought my advice for career or life guidance. That and the grey hairs I have been finding on my pillow. Reflecting back on my career thus far, I have made a few observations. First, being a junior oncologist is really hard. Trying to become independent and finding your way without the camaraderie of your fellowship classmates at your side are enormously difficult. Second, the idealism and enthusiasm that you have when you are in the early part of your career are amazing. At the ASCO Annual Meeting, I saw my fellows and junior colleagues clutching their posters with ferocity and presenting their research with such pride and enthusiasm. I used to think that when you reach the mid-level, the uphill battle of finding your way in oncology would be over and you could just coast for the rest of your career. However, it is daunting to look at all of the amazing things that our senior colleagues have accomplished. Our uphill battle is definitely not over. There is so much more to be done if we want to achieve even a fraction of what our most impressive senior colleagues have been able to do. We mid-level oncologists should keep the enthusiasm of our junior selves as we look forward into the future. The possibilities are endless and we now have enough experience and wisdom under our belts to do even more great things in the years ahead. All things considered, being in the middle is a pretty good place to be. Beverly Moy, MD, MPH Fri, 08 Jun 2012 20:03:52 GMT f1397696-738c-4295-afcd-943feb885714:3239 http://connection.asco.org/Commentary/Article/ID/3180/Optimal-Treatment-of-the-Obese-Patient.aspx#Comments 1 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3180 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3180&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3180/Optimal-Treatment-of-the-Obese-Patient.aspx Odds are that you have been faced with a similar dilemma. I have a new patient, not yet 40 years old, who was recently diagnosed with bilateral locally advanced breast cancer. Staging scans did not reveal metastatic disease. I recommended systemic therapy with doxorubicin, cyclophosphamide, a taxane, and trastuzumab followed by endocrine therapy. Pretty straightforward, right? Here’s the problem: she is 61 inches and weighs 300 pounds. That translates to a body surface area (BSA) of 2.42 and a body mass index (BMI) of 56.7. How should I dose her chemotherapy, given her morbid obesity? I sought advice from many of my medical oncology colleagues, all of whom I respect greatly. There was a true lack of consensus. A few said to “cap” her BSA at 2.0 m2. Others said to use ideal body weight. One colleague suggested that I treat her at full dose but to divide the anthracycline dose over two days. Appropriate dosing of obese patients is a problem that oncologists are increasingly facing. More than 60% of Americans are overweight, obese, or morbidly obese. Some studies have shown that obesity increases the risk of developing certain cancers. Therefore, it is imperative that oncologists know how to optimally treat obese patients with cancer. In my view, ASCO’s new guideline about appropriate chemotherapy dosing for adults with cancer is one of the most clinically useful treatment guidelines I have ever read. This comprehensive document contains an exhaustive systematic review of the literature and makes clear specific recommendations for optimal treatment of our obese patients based on evidence. The panel recommends full weight-based chemotherapy dosing, particularly when the goal of treatment is cure. With several exceptions, the use of fixed-dose chemotherapy is rarely justified. The panel explicitly states that there are no randomized trials of full weight-based chemotherapy vs. nonfull weight-based chemotherapy but based their recommendations on large observational and retrospective studies. It’s a great guideline, and I’d urge every oncology provider to read it. Phew…Now I know what to do with my patient! Beverly Moy, MD, MPH Tue, 03 Apr 2012 14:02:09 GMT f1397696-738c-4295-afcd-943feb885714:3180 http://connection.asco.org/Commentary/Article/ID/3168/Book-Club-HeLa-Cells-and-Research-Ethics.aspx#Comments 0 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3168 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3168&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3168/Book-Club-HeLa-Cells-and-Research-Ethics.aspx Like many oncologists, I am picky about the books I read. I’m not ashamed to say that I favor funny, happy books that make me laugh. There’s enough drama and angst in my day job that I tend to avoid this during my free time. So it was with a tinge of annoyance when a friend thrust “The Immortal Life of Henrietta Lacks” by Rebecca Skloot into my hands, saying, “You must read this.”  Like most of us, I had a superficial knowledge of Henrietta Lacks, a poor black woman who before her death from cervical cancer, provided HeLa cells, the first immortal human cancer cell line. These cells have contributed to countless breakthroughs in medicine, including the development of the polio vaccine, advances in cancer and infectious disease research, and discovery of principles that have led to cloning and in vitro fertilization. But as I read this book, I found that I could not put it down. I was drawn by how the story of Henrietta Lacks is the prime example of why research ethics and disparities in care should remain prominent in the field of oncology. Before Mrs. Lack’s death in 1951, her doctors took a sample of cancer cells from her cervix without her knowledge and this led to the development of the first immortal human cancer cell line. The contribution to medical research that HeLa cells have made is unmistakable. But this all started without her consent. This pattern continued onto her family when researchers later drew blood on her children to further HeLa research without their understanding of why they were being tested. They believed that doctors were screening them for the cancer that killed their mother. As an oncologist and a clinical researcher, I have often found the process of consenting patients, especially for samples and blood draws, to be a hindrance.  Using the Henrietta Lacks example, where would the field of medicine be if she had declined to donate her cells for research? However, the repercussions of her doctors' failure to obtain informed consent from Mrs. Lacks and later, her children, are significant. This experience is further illustration to the African American community that the medical establishment has a history of exploiting blacks and leads to further mistrust of the scientific community. This damage, along with the Tuskegee syphilis study and others, has to be weighed against all the good that HeLa cells have created.  Which brings us to modern-day oncology. It may be tempting to dismiss these past issues as “history” but the truth is that most of these events occurred within our lifetime. As much as a bother informed-consent processes can be, they are important because they protect our patients and they protect the medical community. Emphasis on medical ethics and disparities in care must remain prominent in medicine. Nowhere is that more true than in the field of oncology. Beverly Moy, MD, MPH Wed, 14 Mar 2012 18:49:05 GMT f1397696-738c-4295-afcd-943feb885714:3168 http://connection.asco.org/Commentary/Article/ID/3091/The-OncologistThe-Parent.aspx#Comments 1 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3091 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3091&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3091/The-OncologistThe-Parent.aspx The other morning, National Public Radio publicized a clinical study revealing that working mothers multitask more frequently than working fathers and are more likely to worry that they are inadequate parents. Talk about a perceptive glimpse into the obvious. As my friend, also an oncologist and a mother of young children, commented, “They must have published that study in the journal Duh!” I have two young sons, ages 8 and 11. They are wonderful boys who have had to endure having me as a mother. I could whine that my life is difficult, balancing a career as an oncologist and raising young children, but that would just seem trite. Many other men and women have it much tougher than I have and I count my blessings every day. But I certainly have some emotionally difficult days. For example, this morning, my 8-year-old son had a strings concert at school but I missed it because I was at the San Antonio Breast Cancer Symposium. Children grow up so fast and I am acutely aware that one day, I am going to miss these days. On the other hand, I had important professional commitments at the meeting that I didn’t want to miss. Many trainees, men and women, have asked me how best to balance work and family. Gosh, I wish I had the answer. But I do think that there are two requirements. One: Love what you do. Your kids can tell if you love your job. Two: A supportive partner makes life a whole lot easier. He or she can attend the strings concert that you missed. (Is my guilt obvious?) On the plus side, there are some benefits to being a mom and a doc. Now that my kids are getting older, I have seen them puff out their chests and tell their friends with pride, “My mom is a doctor.” Or when I had to leave home for a hospital emergency, “You’re off to save the day!” So I guess my advice to oncologist parents is that we shouldn’t be so hard on ourselves! Beverly Moy, MD, MPH Tue, 13 Dec 2011 00:27:46 GMT f1397696-738c-4295-afcd-943feb885714:3091 http://connection.asco.org/Commentary/Article/ID/3083/Cancer-Disparities-Scratching-the-Surface.aspx#Comments 0 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3083 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3083&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3083/Cancer-Disparities-Scratching-the-Surface.aspx Fact: If you are African American and you have cancer, you are more likely to die than if you are white. Fact: If you are uninsured and you have cancer, you are more likely to die than if you have medical insurance. We all know this but what are we doing about it? Earlier this month, I had the pleasure of chairing the fall meeting of ASCO’s Health Disparities Advisory Group (HDAG). The members of HDAG are exceptional clinical oncologists and researchers who are committed to promoting cancer equity. In my view, they are the best colleagues and friends you could ask for. HDAG was first established in 2003 when elimination of cancer disparities was formally integrated into ASCO’s Strategic Plan. Since then, with the help of stellar ASCO staff Dana Wollins and Kimberly Head, HDAG has been instrumental in enhancing awareness and education of cancer disparities through content in ASCO’s annual and thematic meetings, the Journal of Clinical Oncology, and ASCO University. HDAG formed the Diversity in Oncology Initiative, a program to increase the number of minority physicians entering oncology and to bring oncology services into underserved communities. More recently, HDAG has helped ASCO to shape its policy priorities after the passing of the health care reform law. We are incredibly excited about our current collaboration with QOPI aimed at improving the quality of cancer care in all populations. We also have joined the NCI in a research collaborative aimed at guiding future disparities research. Here’s the final fact of this blog: While we have made significant strides in addressing cancer disparities, we have a long way to go. Before health care reform, there were cancer disparities. After health care reform, there will be cancer disparities. ASCO’s HDAG continues to be committed to our work. What do you think should be our priorities in the future? Beverly Moy, MD, MPH Tue, 29 Nov 2011 18:54:30 GMT f1397696-738c-4295-afcd-943feb885714:3083 http://connection.asco.org/Commentary/Article/ID/3058/ASCO-Committees.aspx#Comments 0 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3058 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3058&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3058/ASCO-Committees.aspx I am writing this blog while sitting in my favorite chair at Gate 44 in Reagan National Airport. Why, you might ask, would I have a favorite chair at an airport? Because after four years of service on various ASCO committees, I ride an intellectual and professional high after each meeting. I sit in my airport chair with a silly grin on my face, pleased to have one of the best jobs around. Today I had the pleasure of participating in an Ethics Committee meeting. Chaired by my friend and colleague Jeff Peppercorn, we discussed many of the important issues affecting oncologists today, such as financial conflicts of interest, oncology drug shortages, health care reform, and the era of genomic medicine. I feel blessed to be part of this exceptional group of physicians.  Besides having a special research interest and experience in bioethics, all of the committee members are also clinicians who are dealing with these difficult issues on a daily basis.  These are important issues that face most ASCO members. The thoughtful discussions that were held today were extremely thorough, complete, and even thrilling.  And a big thank you goes to the stellar ASCO staff (especially Courtney Storm) for doing all the heavy lifting. As oncologists, we are fortunate to have a society that examines our interests so closely. As an ASCO volunteer, I feel privileged to lend a voice in issues that matter to our entire profession.  Beverly Moy, MD, MPH Wed, 19 Oct 2011 17:02:20 GMT f1397696-738c-4295-afcd-943feb885714:3058 http://connection.asco.org/Commentary/Article/ID/3052/Philanthropy-and-Oncology.aspx#Comments 0 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3052 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3052&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3052/Philanthropy-and-Oncology.aspx As you probably know, October is Breast Cancer Awareness Month. As a breast oncologist, Breast Cancer Awareness Month for me is filled with fundraisers and meetings with philanthropists. Philanthropists are some of my favorite people in the world. In my experience, philanthropists who donate to the cancer cause are inherently good people who usually have been personally touched by the disease. Some have considerable financial means while others give whatever they can. How can you not like spending time with such good people? With so many good causes out there, how do we foster commitment to the cancer cause? What makes giving to cancer research more deserving than any other worthy disease or organization? Over the years, I have struggled with this and have even felt a little guilty about it. But then I realized that this is not a competition. As a cancer care provider, my role is to speak earnestly and honestly about what it’s like to care for people with cancer. The challenges are obvious to us who are in the field but communicating our experiences to people outside of the field is enlightening to potential philanthropists. What we as oncologists can do is speak from the heart (without medical jargon!) and provide information to potential donors to arm them with the information that they need to draw their own conclusions. Given today’s financial climate and the state of cancer research funding, philanthropy is especially needed. Fostering partnerships with our donors has never been more important or necessary. Beverly Moy, MD, MPH Tue, 11 Oct 2011 23:53:51 GMT f1397696-738c-4295-afcd-943feb885714:3052 http://connection.asco.org/Commentary/Article/ID/3037/What-I-Did-On-My-Summer-Vacation.aspx#Comments 1 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3037 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3037&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3037/What-I-Did-On-My-Summer-Vacation.aspx I was really, really ready for my summer vacation this year. As I’m sure you agree, taking care of patients with cancer can be physically and emotionally exhausting. Limping through the last weeks of August, I couldn’t wait to sit on the beach with my husband and two sons without my cell phone or my wristwatch. Then before my vacation, one of my patients with advanced breast cancer asked me what I was doing on the afternoon of September third. “Well,” I answered, “I had planned to be hiding on Cape Cod. Why do you ask?” She had been asked to sing the National Anthem at Fenway Park before the Red Sox/Rangers game and she wanted to know if I would accompany her and her husband out on the field. What an amazing afternoon. A small army of her friends and family bought tickets to the game to lend their support (no small feat at perpetually sold-out Fenway Park). Standing out on the field with my patient and her husband as she sang the anthem was a surreal experience and not just because she sang so beautifully. I was struck that of all the people in her life that she could have brought out to the field with her, she chose me, her oncologist. That is incredibly humbling. How many other professions allow for such a privileged position in people’s lives? The experience made me even prouder to be caring for people with cancer. Now I’m back at work and summer vacation is over. The week at the beach was great but I must admit that the most rejuvenating thing I did during my summer vacation was spending time with a patient. And in case you are wondering, the Red Sox beat the Rangers, 12-7! Beverly Moy, MD, MPH Wed, 14 Sep 2011 19:02:51 GMT f1397696-738c-4295-afcd-943feb885714:3037 http://connection.asco.org/Commentary/Article/ID/3003/Health-Care-Reform-and-Cancer-Care-Disparities.aspx#Comments 2 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=3003 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=3003&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/3003/Health-Care-Reform-and-Cancer-Care-Disparities.aspx Yesterday, the Journal of Clinical Oncology released an ASCO Policy Statement addressing the challenges and opportunities in U.S. health care reform to reduce cancer care disparities. Developing this statement was a hugely collaborative effort between ASCO’s Health Disparities Advisory Group and Government Relations Committee. I am honored to serve as this year’s Chair of the Health Disparities Advisory Group and to have led the team in developing this policy statement. The purpose of this statement is a call to action for the entire ASCO membership and for policymakers to join together and demand implementation of the provisions of the health care reform law that have the potential to reduce cancer care disparities. Ensuring access to quality cancer care for all individuals with cancer is paramount. Among our most important recommendations going forward is to stop cuts to Medicare reimbursement.The promise of health care reform remains in tremendous jeopardy given our current political environment. I write this blog post just as the U.S. Senate passed the bill to raise the national debt ceiling and just before President Obama signs this bill into law. While access to cancer care is temporarily protected by Congress, this protection is only temporary. Under the agreement to raise the debt ceiling, a congressional committee is charged with examining Medicare spending as it looks for ways to protect the program’s solvency. This committee could potentially decide on future Medicare cuts. Most likely, the savings would come from paying doctors and hospitals less for treating Medicare patients.I urge the entire ASCO membership to be aware of these issues. Read the ASCO Policy Statement. Read the “ASCO in Action” section of ASCO.org. Speak to your representatives. The promise of health care reform depends on our commitment to the cause of ensuring access to quality cancer care to all individuals with cancer, especially our most vulnerable patients. I’d be interested in hearing opinions and comments from the ASCO membership. Beverly Moy, MD, MPH Tue, 02 Aug 2011 18:18:11 GMT f1397696-738c-4295-afcd-943feb885714:3003